Abstract
Atezolizumab plus Bevacizumab Followed by Curative Conversion Using Microwave Ablation in Initially Unresectable, TACE-unsuitable Hepatocellular Carcinoma: A Realistic Concept in HCC Treatment
Rene John D. Febro1, Akemi A. Kimura1, Engelbert Simon S. Perillo2, Stephen N. Wong3
1Fellow-in-Training, Section of Gastroenterology, University of Santo Tomas Hospital
2Hepatology Fellow, University of Santo Tomas Hospital
3Consultant, Section of Gastroenterology, University of Santo Tomas Hospital
Significance: Hepatocellular carcinoma (HCC) contributes to a substantial number of deaths worldwide often because it is diagnosed in advanced stages where curative therapies are restricted. Atezolizumab-plus-bevacizumab (atezo-bev) has been recently approved as first-line treatment in cases of advanced HCC and could potentially result to significant downstaging where a curative therapeutic option, particularly resection or ablation, can be performed. We present two cases of initially unresectable, TACE-unsuitable HCCs who successfully underwent curative microwave ablation following atezo-bev therapy.
Clinical Presentation: Case 1 is a 71-year-old male with hepatitis C infection presenting with anorexia. CT scan showed portal vein thrombosis (PVT) on top of multiple hepatic masses at the right lobe. Case 2 is a 72-year-old obese, diabetic male with progressive abdominal pain. Imaging showed a huge solitary infiltrative mass at the right hepatic lobe. Both cases exhibited classic features of HCC on triphasic CT scan. Case 1 is a 71-year-old male with hepatitis C infection presenting with anorexia. CT scan showed portal vein thrombosis (PVT) on top of multiple hepatic masses at the right lobe. Case 2 is a 72-year-old obese, diabetic male with progressive abdominal pain. Imaging showed a huge solitary infiltrative mass at the right hepatic lobe. Both cases exhibited classic features of HCC on triphasic CT scan.
Management: Our patients received sequential treatment using atezo-bev and single session of TACE. Case 1 received six cycles of atezo-bev with note of decrease in tumor size and disappearance of PVT. For case 2, marked reduction in tumor size was noted after nine cycles of atezo-bev. Microwave ablation of the viable tumors was then performed. Follow-up imaging showed complete ablation of the hepatic tumors.
Recommendation: To our knowledge, our patients are the first documented cases of advanced HCCs who were successfully downstaged using atezo-bev therapy followed by curative microwave ablation. Data from large, prospective, randomized-controlled trials are needed to verify the real clinical benefit of this strategy.
Keywords: case report; hepatocellular carcinoma; atezolizumab; bevacizumab; trans-arterial chemoembolization; microwave ablation
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |